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Rickets is a preventable bone disease that causes weak, soft bones. If a child has softer bones, the bones can bend and become an abnormal shape. Rickets only occurs in growing bones, so it mostly occurs in infants and young children, but it can also occur in teenagers. It is most
common when children are growing quickly.
Rickets is usually caused by low vitamin D, especially if children also have low calcium or low phosphate intake. Calcium and phosphate are minerals that are mostly found in milk and dairy foods, and they are important for healthy, strong bones.
Rickets is not common. Nearly all cases of rickets in Australia occur in infants and children who have migrated to Australia, or whose parents migrated to Australia. The risk factors for rickets are the same as the risk factors for low vitamin D. There are conditions associated with inherited
forms of rickets, but these are extremely rare. Sometimes kidney problems cause rickets by affecting how the body handles vitamin D, calcium and phosphate.
If your child has rickets, they may have:
Infants and children with rickets are often grumpy and irritable because their bones are sore. Sometimes babies with rickets can have symptoms of very low calcium levels, such as muscle cramps or seizures. Seizures from low calcium mostly happen in babies who are less than one year
old (but can occur in older children too).
If your child has any of the symptoms of rickets, or the symptoms of low calcium levels, take them to a GP as soon as possible. Your child will be referred to see a specialist urgently.
The specialist will have your child undertake blood tests (to check vitamin D, calcium balance, phosphate, kidney function, and bone turnover), urine tests and X-rays.
Although rickets is usually caused by low vitamin D, most children with low vitamin D do not get rickets. Rickets is more likely in babies and children who also have low dairy intake, and in babies who breastfeed for a long time without starting solid foods at the normal age
(around four to six months).
For children (or unborn babies) at risk of low vitamin D, rickets can be prevented by:
Including foods with vitamin D in your child's diet may help prevent rickets. Foods with vitamin D include fresh fatty fish (e.g. salmon, herring, mackerel and sardines), liver, some mushrooms and egg yolks. Some foods have vitamin D added, such as margarine and some breakfast cereals or
However, foods only provide a small amount (10 per cent or less) of daily vitamin D needs for most people in Australia, and safely spending enough time in the sun is the best way to prevent low vitamin D. See our fact sheet Vitamin D.
Children with dark skin who live in the southern parts of Australia should have extra vitamin D supplements during winter.
Regular follow-up with a paediatrician is needed to ensure that healthy levels of vitamin D, calcium and phosphate are maintained. You child will have:
If my child has bow legs, will they straighten up once she
is getting more vitamin D?
Usually, within three months of treatment, an improvement in
bone health and shape are visible on X-rays. With medical treatment alone, most
bow legs improve dramatically and surgery is not necessary. If there is
insufficient straightening, your child will be referred to a bone specialist
(orthopaedic surgeon) for review.
If my child has rickets are they likely to have bone
problems later in life?
Your child should be monitored closely to make
sure they continue to have good vitamin D, calcium and phosphate levels. Once
the bone abnormalities are corrected in childhood, your child is not likely to
have bone problems later in life.
Developed by The Royal Children's Hospital Gastroenterology, General Medicine and Dietetics departments. We acknowledge the input of RCH consumers and carers.
Reviewed May 2018.
This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.
Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.